Depression symptoms and suicidal ideation among HIV infected Rwandans: the mediating and moderating effects of complicated grief and substance abuse.

BACKGROUND: People with HIV/AIDS (PWHA) have 7-36 times greater risk for completed suicide associated with depression symptoms compared to general population. However, no study has sufficiently analyzed the mediating or moderating variables of the relationship between depression and suicidal ideation in Rwanda. OBJECTIVES: This study aimed to examine how complicated grief mediates and substance abuse moderates the effects of depression symptoms on suicidal ideation. METHODS: Data were collected from a convenient sample of 140 participants (M-age = 38.79 years, SD = 10.218) receiving antiretroviral therapy (ART) at Remera Health Center in a cross-sectional study. Multiple linear regression and Sobel test were used to examine the relationships between depression symptoms, complicated grief, suicidal ideation, and substance abuse. RESULTS: The results indicated that 29% of the sample had clinically significant symptoms of depression and 18% had suicidal ideation. The interaction between substance abuse and depression symptoms (ß = .468, t = 8.02, p = 0.000) was a significant predictor, explaining the 55.7% of variance in suicidal ideation. Furthermore, the Sobel test demonstrated that complicated grief mediated the effects of depression symptoms (t = 4.67, SE = 0.0101, p ≤ 0.001) on suicidal ideation. CONCLUSION: The results suggest that depression symptoms are associated with an increased risk of suicidal ideation, and this risk significantly amplified in the presence of complicated grief and substance abuse. These findings highlight the importance of integrating mental health services, particularly those addressing depression, complicated grief, and substance abuse, into HIV care programs to mitigate the risk of suicidal ideation among PWHA.

Adolescents' perspectives regarding their communication with reproductive health service providers in Rwanda: an explorative study.

BACKGROUND: Adolescents in low-middle-income countries often face limited access to health information and services due to several different factors. Ineffective communication between healthcare providers and adolescents is among them. This study aims to assess adolescents' perspectives regarding their communication with reproductive health service providers in Rwanda. METHODS: A phenomenological exploratory qualitative study was used. Eleven focus group discussions were conducted among adolescents aged 10 to 19 years between December 2020 and January 2021. All participants were identified through their respective health care providers in youth-friendly centres available in the Kigali district representing the urban area and Kamonyi district representing the rural area. All interviews were transcribed and translated into English and analysed by using thematic content analysis. RESULTS: Poor communication between healthcare providers and adolescents was identified and attributed to the judgmental attitudes of some healthcare providers, while good communication was cited by many adolescents as an important key of access to services. All adolescents were eager to access reproductive health services and be educated about reproductive health issues. CONCLUSION: Effective communication is essential when it comes to providing reproductive health services, as this establishes a strong relationship between a service provider and an adolescent who wants to talk about their concerns, while poor communication prevents adolescents from asking questions about unknown topics.

A qualitative analysis of negative feelings among incarcerated filicide mothers in Rwanda.

BACKGROUND: Most of the research on filicide mothers suggests that they experience negative feelings before they kill their child. However, little is known about whether these negative feelings can be expressed after one-year post-offense among incarcerated filicide mothers with no history of psychiatric problems. In this study, we aimed to conduct a qualitative analysis to (a) understand negative feelings evolving from negative emotions such as anger, guilt, shame, depression, and anxiety among filicide mothers incarcerated in Nyarugenge Prison in Rwanda, (b) identify the impact of experienced negative feelings on their personal wellbeing, and (c) explore their coping strategies. METHODS: This study adopted a phenomenology research design and face-to-face in-depth interviews to explore the problem among twenty filicide mothers selected from Nyarugenge prison. Data were audio recorded, transcribed verbatim, organized, and analysed by using ATLAS.ti 8 Windows. RESULTS: Anxious and depressed participants experienced both physical and emotional negative feelings. Social withdrawal and cognitive problems were expressed by anxious participants, while avoidance behaviours were particularly experienced by depressed participants. Intolerance created anger, while self-blame, regret, and acute stress created guilt. In addition, avoidance behaviours and poor self-judgment emerged from shame. Participants felt disconnected from their community and worried about a variety of issues because of their negative feelings. To cope with negative feelings, participants reported that they used abnormal defense, surrender and support from community resources. DISCUSSION: Our findings highlight the overall negative feelings of incarcerated filicide mothers, which can guide mental health professionals and different stakeholders to respond with appropriate interventions.

Prevalence and Family Determinants of Geriatric Depression Among Elderly People in Elderly Support Groups in Rwanda.

Background: The 1994 Tutsi genocide in Rwanda significantly impacted family structure, with many people growing old alone and lacking social bonds and connections with family members. However, little is known about the contribution of the family environment to geriatric depression which was highlighted by WHO as a psychological problem with a 10% to 20% prevalence rate among the elderly worldwide. This study aims to investigate geriatric depression and associated family determinants among the elderly in Rwanda. Methods: With a community-based cross-sectional study design, we assessed geriatric depression (GD), quality-of-life enjoyment and satisfaction (QLES), family support (FS), loneliness, neglect, and attitude toward grief in a convenience sample of 107 participants (M=72.32, SD=8.79) aged between 60 and 95 years who were recruited from three groups of elderly people supported by the NSINDAGIZA organization in Rwanda. SPSS (version 24) was used for statistical data analysis; differences across various sociodemographic variables were tested for significance by an independent t-test; the relationship between study variables was tested by Pearson correlation analysis; and multiple regression analysis was performed to model the contribution of independent variables to dependent variables. Results: A total of 64.5% of the elderly scored above the threshold of the normal range of geriatric depression (SDS>49), with higher symptoms in women than in men. Multiple regression analysis indicated that family support and quality-of-life enjoyment and satisfaction were contributors to geriatric depression in the participants. Conclusion: Geriatric depression was relatively common in our participants. It is associated with the quality of life and family support received. Hence, adequate family-based interventions are needed to improve the well-being of geriatric people in their respective families.

Negative emotions and personal well-being among incarcerated filicide mothers in Rwanda.

Despite the tremendous evidence of the harmful effects of maternal filicide on the lives of offenders, there is a scarcity on studies of their negative emotions and personal wellbeing especially in sub-Saharan Africa. Thus, this study was primarily aimed at assessing the prevalence of negative emotions experienced by filicide mothers and how they were associated with personal wellbeing in Rwanda. With an institutional-based cross-sectional study design, we measured the symptoms of anxiety, anger, shame, guilt, depression and personal well-being in a convenient sample of 55 filicidal mothers (mean age = 26.69; SD = 6.88) who were incarcerated in Nyarugenge prison. SPSS (version 24) was used to compute descriptive, Pearson correlation, independent t-test and regression analyses. The results indicated that the rates of shame were (100%), guilt (98.2%), anxiety (92.7%), depression (92.7%), low happiness and satisfaction with life (81.8%), and anger was (76.4%) in the current sample. Based on age category, there was no significant difference in anger scores, depression, guilt, shame and personal well-being scores between young and adult filicide mothers (p>.05). Young filicide mothers (M = 14.55, SD = 4.03), on the other hand, had higher anxiety scores than adult filicide mothers (M = 11.57, SD = 4.72), t = 2.52, p = .015. Finally, anxiety (ß = -.507, t = -3.478, p = .001) and age (ß = -.335, t = -2.685, p < .001) were negatively associated with personal well-being. The results emerged from this study highlight that filicide mothers experience substantial negative emotions and poor personal wellbeing regardless of their age category. However, poor personal wellbeing was associated with anxiety and age. Based on these results, mental health professionals should examine their mental state with respect to negative emotions and initiate programs that decrease the emotions as well as increase personal well-being.